Surgical clip applier with wide aperture surgical clips

ABSTRACT

An end effector for a surgical clip applier includes an elongate body and a clip track provided within the body and containing one or more surgical clips. Each surgical clip includes a crown and a pair of legs extending longitudinally from the crown and diverging from each other at a diverging opening angle. A pre-forming region is provided within the body and arranged to receive and deform the one or more surgical clips from a first state, where the pair of legs diverge at the diverging opening angle, and a second state, where the diverging opening angle is minimized. First and second jaw members are positioned at a distal end of the body and arranged to receive the one or more surgical clips from the pre-forming region in the second state.

BACKGROUND

Minimally invasive surgical (MIS) tools and procedures are oftenpreferred over traditional open surgical approaches due to theirpropensity toward reducing post-operative recovery time and leavingminimal scarring. Endoscopic surgery is one type of MIS procedure inwhich a surgical tool operably connected to an elongate shaft isintroduced into the body of a patient through a natural bodily orifice.Laparoscopic surgery is a related type of MIS procedure in which a smallincision is formed in the abdomen of a patient and a trocar is insertedthrough the incision to form a surgical access pathway for a surgicaltool and elongate shaft. Once located within the abdomen, the surgicaltool engages and/or treats tissue in a number of ways to achieve adiagnostic or therapeutic effect. Manipulation and engagement of thesurgical tool may take place via various components passing through theelongate shaft.

One surgical instrument commonly used with a trocar is a surgical clipapplier, which can be used to ligate blood vessels, ducts, shunts, orportions of body tissue during surgery. Traditional surgical clipappliers have a handle and an elongate shaft extending from the handle.A pair of movable opposed jaws is positioned at the end of the elongateshaft for holding and forming a surgical clip or “ligation clip”therebetween. In operation, a user (e.g., a surgeon or clinician)positions the jaws around the vessel or duct and squeezes a trigger onthe handle to close the jaws and thereby collapse the surgical clip overthe vessel.

More recently, however, robotic systems have been developed to assist inMIS procedures. Instead of directly engaging a surgical instrument,users are now able to manipulate and engage surgical instruments via anelectronic interface communicatively coupled to a robotic manipulator.With the advances of robotic surgery, a user need not even be in theoperating room with the patient during the surgery.

Robotic surgical systems are also now capable of utilizing roboticallycontrolled clip appliers. Such clip appliers include features forrobotically feeding and forming surgical clips. Advances andimprovements to the methods and devices for applying surgical clips tovessels, ducts, shunts, etc. is continuously in demand to make theprocess more efficient and safe.

BRIEF DESCRIPTION OF THE DRAWINGS

The following figures are included to illustrate certain aspects of thepresent disclosure, and should not be viewed as exclusive embodiments.The subject matter disclosed is capable of considerable modifications,alterations, combinations, and equivalents in form and function, withoutdeparting from the scope of this disclosure.

FIG. 1 is a block diagram of an example robotic surgical system that mayincorporate some or all of the principles of the present disclosure.

FIG. 2 is an isometric top view of an example surgical tool that mayincorporate some or all of the principles of the present disclosure.

FIG. 3 is an isometric bottom view of the surgical tool of FIG. 2.

FIG. 4 is an exploded view of the elongate shaft and the end effector ofthe surgical tool of FIGS. 2 and 3.

FIG. 5 is an exposed isometric view of the surgical tool of FIG. 2.

FIG. 6 is a side view of an example surgical tool that may incorporatesome or all of the principles of the present disclosure.

FIG. 7 illustrates potential degrees of freedom in which the wrist ofFIG. 1 may be able to articulate (pivot).

FIG. 8 is an enlarged isometric view of the distal end of the surgicaltool of FIG. 6.

FIG. 9 is a bottom view of the drive housing of the surgical tool ofFIG. 6.

FIG. 10 is an isometric exposed view of the interior of the drivehousing of the surgical tool of FIG. 6.

FIGS. 11A-11C are partial cross-sectional top views of a portion of anexample end effector.

FIGS. 12A-12C are partial cross-sectional side views of the end effectorof FIGS. 11A-11C.

FIGS. 13A-13E are partial cross-sectional top views of a distal portionof another example end effector.

FIGS. 14A-14C are partial cross-sectional side views of the end effectorof FIGS. 13A-13E.

FIGS. 15A and 15B are partial cross-sectional top views of a distalportion of another example end effector.

DETAILED DESCRIPTION

The present disclosure is related to surgical systems and, moreparticularly, to surgical clip appliers having an end effector thatstores wide angle surgical clips and transitions the wide angle surgicalclips to tissue-ready surgical clips ready for crimping between opposedjaw members.

Embodiments discussed herein describe improvements to clip applier endeffectors. The end effectors described herein include an elongate bodyand a clip track provided within the body and containing one or moresurgical clips. Each surgical clip includes a crown and a pair of legsextending longitudinally from the crown and diverging from each other ata diverging opening angle. A pre-forming region is provided within thebody and arranged to receive and deform the one or more surgical clipsfrom a first state, where the pair of legs diverge at the divergingopening angle, and a second state, where the diverging opening angle isminimized. First and second jaw members are positioned at a distal endof the body and arranged to receive the one or more surgical clips fromthe pre-forming region in the second state. Storing the surgical clipsin the clip track in the first state allows the surgical clips to bearranged in a nested relationship, which decreases the overall length ofthe end-effector. The pre-forming region is used to transition thesurgical clips into the second state or a “tissue-ready” state capableof being received between the jaw members and crimped over tissue asdesired.

In contrast to conventional clip appliers, the surgical clips may bereceived by the jaw members crown first, which helps mitigate catchingthe surgical clips on any sharp corners that might obstruct their distaladvancement. Moreover, the presently described jaw members may compriseindependent or separate plate-like structures that may proveadvantageous in facilitating parallel closure of the jaw members, whichcan reduce the force required to crimp a surgical clip.

FIG. 1 is a block diagram of an example robotic surgical system 100 thatmay incorporate some or all of the principles of the present disclosure.As illustrated, the system 100 can include at least one mastercontroller 102 a and at least one arm cart 104. The arm cart 104 may bemechanically and/or electrically coupled to a robotic manipulator and,more particularly, to one or more robotic arms 106 or “tool drivers”.Each robotic arm 106 may include and otherwise provide a location formounting one or more surgical tools or instruments 108 for performingvarious surgical tasks on a patient 110. Operation of the robotic arms106 and instruments 108 may be directed by a clinician 112 a (e.g., asurgeon) from the master controller 102 a.

In some embodiments, a second master controller 102 b (shown in dashedlines) operated by a second clinician 112 b may also direct operation ofthe robotic arms 106 and instruments 108 in conjunction with the firstclinician 112 a. In such embodiments, for example, each clinician 102a,b may control different robotic arms 106 or, in some cases, completecontrol of the robotic arms 106 may be passed between the clinicians 102a,b. In some embodiments, additional arm carts (not shown) havingadditional robotic arms (not shown) may be utilized during surgery on apatient 110, and these additional robotic arms may be controlled by oneor more of the master controllers 102 a,b.

The arm cart 104 and the master controllers 102 a,b may be incommunication with one another via a communications link 114, which maybe any type of wired or wireless telecommunications mean configured tocarry a variety of communication signals (e.g., electrical, optical,infrared, etc.) according to any communications protocol.

The master controllers 102 a,b generally include one or more physicalcontrollers that can be grasped by the clinicians 112 a,b andmanipulated in space while the surgeon views the procedure via a stereodisplay. The physical controllers generally comprise manual inputdevices movable in multiple degrees of freedom, and which often includean actuatable handle for actuating the surgical instrument(s) 108, forexample, for opening and closing opposing jaws, applying an electricalpotential (current) to an electrode, or the like. The master controllers102 a,b can also include an optional feedback meter viewable by theclinicians 112 a,b via a display to provide a visual indication ofvarious surgical instrument metrics, such as the amount of force beingapplied to the surgical instrument (i.e., a cutting instrument ordynamic clamping member).

Example implementations of robotic surgical systems, such as the system100, are disclosed in U.S. Pat. No. 7,524,320, the contents of which areincorporated herein by reference. The various particularities of suchdevices will not be described in detail herein beyond that which may benecessary to understand the various embodiments and forms of the variousembodiments of robotic surgery apparatus, systems, and methods disclosedherein.

FIG. 2 is an isometric top view of an example surgical tool 200 that mayincorporate some or all of the principles of the present disclosure. Thesurgical tool 200 may be the same as or similar to the surgicalinstrument(s) 108 of FIG. 1 and, therefore, may be used in conjunctionwith the robotic surgical system 100 of FIG. 1. Accordingly, thesurgical tool 200 may be designed to be releasably coupled to a roboticarm 106 (FIG. 1) of a robotic manipulator of the robotic surgical system100. Full detail and operational description of the surgical tool 200 isprovided in U.S. Patent Pub. 2016/0287252, entitled “Clip ApplierAdapted for Use with a Surgical Robot,” the contents of which are herebyincorporated by reference in their entirety.

While the surgical tool 200 is described herein with reference to arobotic surgical system, it is noted that the principles of the presentdisclosure are equally applicable to non-robotic surgical tools or, morespecifically, manually operated surgical tools. Accordingly, thediscussion provided herein relating to robotic surgical systems merelyencompasses one example application of the presently disclosed inventiveconcepts.

As illustrated, the surgical tool 200 can include an elongate shaft 202,an end effector 204 coupled to the distal end of the shaft 202, and adrive housing 206 coupled to the proximal end of the shaft 202. Theterms “proximal” and “distal” are defined herein relative to a roboticsurgical system having an interface configured to mechanically andelectrically couple the surgical tool 200 (e.g., the drive housing 206)to a robotic manipulator. The term “proximal” refers to the position ofan element closer to the robotic manipulator and the term “distal”refers to the position of an element closer to the end effector 204 andthus further away from the robotic manipulator. Moreover, the use ofdirectional terms such as above, below, upper, lower, upward, downward,left, right, and the like are used in relation to the illustrativeembodiments as they are depicted in the figures, the upward or upperdirection being toward the top of the corresponding figure and thedownward or lower direction being toward the bottom of the correspondingfigure.

In applications where the surgical tool 200 is used in conjunction witha robotic surgical system (e.g., system 100 of FIG. 1), the drivehousing 206 can include a tool mounting portion 208 designed withfeatures that releasably couple the surgical tool 200 to a robotic arm(e.g., the robotic arms 106 or “tool drivers” of FIG. 1) of a roboticmanipulator. The tool mounting portion 208 may releasably attach(couple) the drive housing 206 to a tool driver in a variety of ways,such as by clamping thereto, clipping thereto, or slidably matingtherewith. In some embodiments, the tool mounting portion 208 mayinclude an array of electrical connecting pins, which may be coupled toan electrical connection on the mounting surface of the tool driver.While the tool mounting portion 208 is described herein with referenceto mechanical, electrical, and magnetic coupling elements, it should beunderstood that a wide variety of telemetry modalities might be used,including infrared, inductive coupling, or the like.

FIG. 3 is an isometric bottom view of the surgical tool 200. Thesurgical tool 200 further includes an interface 302 that mechanicallyand electrically couples the tool mounting portion 208 to a roboticmanipulator. In various embodiments, the tool mounting portion 208includes a tool mounting plate 304 that operably supports a plurality ofdrive inputs, shown as a first drive input 306 a, a second drive input306 b, and a third drive input 306 c. While only three drive inputs 306a-c are shown in FIG. 3, more or less than three may be employed,without departing from the scope of the disclosure.

In the illustrated embodiment, each drive input 306 a-c comprises arotatable disc configured to align with and couple to a correspondinginput actuator (not shown) of a given tool driver. Moreover, each driveinput 306 a-c provides or defines one or more surface features 308configured to align with mating surface features provided on thecorresponding input actuator. The surface features 308 can include, forexample, various protrusions and/or indentations that facilitate amating engagement.

FIG. 4 is an exploded view of one example of the elongate shaft 202 andthe end effector 204 of the surgical tool 200 of FIGS. 2 and 3,according to one or more embodiments. As illustrated, the shaft 202includes an outer tube 402 that houses the various components of theshaft 202, which can include a jaw retaining assembly 404. The jawretaining assembly 404 includes a jaw retainer shaft 406 with a cliptrack 408 and a push rod channel 410 formed thereon. The end effector204 includes opposing jaws 412 that are configured to mate to a distalend of the clip track 408.

The shaft 202 also includes a clip advancing assembly, which, in oneexample embodiment, can include a feeder shoe 414 adapted to be slidablydisposed within the clip track 408. The feeder shoe 414 is designed toadvance a series of clips 416 positioned within the clip track 408, anda feedbar 418 is adapted to drive the feeder shoe 414 through the cliptrack 408. An advancer assembly 420 is adapted to mate to a distal endof the feedbar 418 for advancing a distal-most clip into the jaws 412.

The shaft 202 furthers include a clip forming or camming assemblyoperable to collapse the jaws 412 and thereby crimp (crush) a surgicalclip 416 positioned between (interposing) the jaws 412. The cammingassembly includes a cam 422 that slidably mates to the jaws 412, and apush rod 424 that moves the cam 422 relative to the jaws 412 to collapsethe jaws 412. A tissue stop 426 can mate to a distal end of the cliptrack 408 to help position the jaws 412 relative to a surgical site.

The jaw retainer shaft 406 is extendable within and couples to the outertube 402 at a proximal end 428 a, and its distal end 428 b is adapted tomate with the jaws 412. The push rod channel 410 formed on the jawretainer shaft 406 may be configured to slidably receive the push rod424, which is used to advance the cam 422 over the jaws 412. The cliptrack 408 extends distally beyond the distal end 428 b of the jawretainer shaft 406 to allow a distal end of the clip track 408 to besubstantially aligned with the jaws 412.

The clip track 408 can include several openings 430 formed therein forreceiving an upper or “superior” tang 432 a formed on the feeder shoe414 adapted to be disposed within the clip track 408. The clip track 408can also include a stop tang 434 formed thereon that is effective to beengaged by a corresponding stop tang formed on the feeder shoe 414 toprevent movement of the feeder shoe 414 beyond a distal-most position.To facilitate proximal movement of the feeder shoe 414 within the cliptrack 408, the feeder shoe 414 can also include a lower or “inferior”tang 432 b formed on the underside thereof for allowing the feeder shoe414 to be engaged by the feedbar 418 as the feedbar 418 is moveddistally. In use, each time the feedbar 418 is moved distally, a detentformed in the feedbar 418 engages the inferior tang 432 b and moves thefeeder shoe 414 distally a predetermined distance within the clip track408. The feedbar 418 can then be moved proximally to return to itsinitial position, and the angle of the inferior tang 432 b allows theinferior tang 432 b to slide into the next detent formed in the feedbar418.

The jaws 412 include first and second opposed jaw members that aremovable (collapsible) relative to one another and are configured toreceive a surgical clip from the series of clips 416 therebetween. Thejaw members can each include a groove formed on opposed inner surfacesthereof for receiving the legs of a surgical clip 416 in alignment withthe jaw members. In the illustrated embodiment, the jaw members arebiased to an open position and a force is required to urge the jawmembers toward one another to crimp the interposing clip 416. The jawmembers can also each include a cam track formed thereon for allowingthe cam 422 to slidably engage and move the jaw members toward oneanother. A proximal end 436 a of the cam 422 is matable with a distalend 438 a of the push rod 424, and a distal end 436 b of the cam 422 isadapted to engage and actuate the jaws 412. The proximal end 438 b ofthe push rod 424 is matable with a closure link assembly associated withthe drive housing 206 for moving the push rod 424 and the cam 422relative to the jaws 412.

The distal end 436 b of the cam 422 includes a camming channel ortapering recess formed therein for slidably receiving corresponding camtracks provided by the jaw members. In operation, the cam 422 isadvanced from a proximal position, in which the jaw members are spacedapart from one another, to a distal position, where the jaw members arecollapsed to a closed position. As the cam 422 is advanced over the jawmembers, the tapering recess at the distal end 436 b serves to push thejaw members toward one another, thereby crimping a surgical clip 416disposed therebetween.

FIG. 5 is an exposed isometric view of the surgical tool 200 of FIG. 2,according to one or more embodiments. The shroud or covering of thedrive housing 206 has been removed to reveal the internal componentparts. As illustrated, the surgical tool 200 may include a first drivegear 502 a, a second drive gear 502 b, and a third drive gear 502 c. Thefirst drive gear 502 a may be operatively coupled to (or extend from)the first drive input 306 a (FIG. 3) such that actuation of the firstdrive input 306 a correspondingly rotates the first drive gear 502 a.Similarly, the second and third drive gears 502 b,c may be operativelycoupled to (or extend from) the second and third drive inputs 306 b,c(FIG. 3), respectively, such that actuation of the second and thirddrive inputs 306 b,c correspondingly rotates the second and third drivegears 502 b,c, respectively.

The first drive gear 502 a may be configured to intermesh with a firstdriven gear 504 a, which is operatively coupled to the shaft 202. In theillustrated embodiment, the driven gear 504 a comprises a helical gear.In operation, rotation of the first drive gear 502 a about a first axiscorrespondingly rotates the first driven gear 504 a about a second axisorthogonal to the first axis to control rotation of the shaft 202 inclockwise and counter-clockwise directions based on the rotationaldirection of the first drive gear 502 a.

The second drive gear 502 b may be configured to intermesh with a seconddriven gear 504 b (partially visible in FIG. 5), and the third drivegear 502 c may be configured to intermesh with a third driven gear 504c. In the illustrated embodiment, the second and third drive and drivengears 502 b,c, 504 b,c comprise corresponding rack and pinioninterfaces, where the driven gears 504 b,c comprise the rack and thedrive gears 502 b,c comprise the pinion. Independent rotation of thesecond and third drive gears 502 b,c will cause the second and thirddriven gears 504 b,c, respectively, to translate linearly relative to(independent of) one another.

In at least one embodiment, actuation (rotation) of the third drive gear502 c will result in a surgical clip 416 (FIG. 4) being fed into thejaws 412. More particularly, the third driven gear 504 c may beoperatively coupled to the feedbar 418 (FIG. 4) and, upon rotation ofthe third drive gear 502 c in a first angular direction, the thirddriven gear 504 c will advance distally and correspondingly advance thefeedbar 418 a sufficient distance to fully advance a surgical clip intothe jaws 412. Rotation of the third drive gear 502 c may be preciselycontrolled by an electrical and software interface to deliver the exactlinear travel to the third driven gear 504 c necessary to feed a clip416 into the jaws 412.

Upon delivery of a clip into the jaws 412, or after a predeterminedamount of rotation of the third drive gear 502 c, rotation of the thirddrive gear 502 c is reversed in a second angular direction to move thethird driven gear 504 c linearly in a proximal direction, whichcorrespondingly moves the feedbar 418 proximally. This process may berepeated several times to accommodate a predetermined number of clipsresiding in the shaft 202.

Actuation of the second drive gear 502 b causes the jaws 412 to close orcollapse to crimp a surgical clip. More particularly, the second drivengear 504 b may be coupled to the proximal end 438 b (FIG. 4) of the pushrod 424 (FIG. 4) and, upon actuation of the second drive gear 502 b in afirst angular direction, the second driven gear 504 b will be advancedlinearly in a distal direction and correspondingly drive the push rod424 distally, which drives the cam 422 over the jaws 412 to collapse thejaw members and crimp a surgical clip positioned in the jaws 412. Once asurgical clip is successfully deployed, rotation of the second drivegear 502 b is reversed in the opposite angular direction to move thesecond driven gear 504 b in a proximal direction, which correspondinglymoves the push rod 424 and the cam 422 proximally and permits the jaws412 to open once again.

The processes of delivering a surgical clip into the jaws 412 andcollapsing the jaws 412 to crimp the surgical clip are not limited tothe actuation mechanisms and structures described herein. In alternativeembodiments, for example, the second and third driven gears 504 b,c mayinstead comprise capstan pulleys configured to route and translate drivecables within the shaft 202. In such embodiments, the drive cables maybe operatively coupled to one or more lead screws or other types ofrotating members positioned within the shaft 202 near the distal end andcapable of advancing the feedbar 418 to deliver a surgical clip into thejaws 412 and advancing the cam 422 to collapse the jaws 412 and crimpthe surgical clip.

FIG. 6 is an isometric top view of another example surgical tool 600that may incorporate some or all of the principles of the presentdisclosure. Similar to the surgical tool 200 of FIG. 2, the surgicaltool 600 may be used in conjunction with the robotic surgical system 100of FIG. 1. As illustrated, the surgical tool 600 includes an elongateshaft 602, an end effector 604 positioned at the distal end of the shaft602, a wrist 606 (alternately referred to as a “articulable wristjoint”) that couples the end effector 604 to the distal end of the shaft602, and a drive housing 608 coupled to the proximal end of the shaft602. In some embodiments, the shaft 602, and hence the end effector 604coupled thereto, is configured to rotate about a longitudinal axis A₁.

In the illustrated embodiment, the end effector 604 comprises a clipapplier that includes opposing jaw members 610, 612 configured tocollapse toward one another to crimp a surgical clip. The wrist 606comprises an articulatable joint that facilitates pivoting movement ofthe end effector 604 relative to the shaft 602 to position the endeffector 604 at desired orientations and locations relative to asurgical site. The housing 608 includes (contains) various actuationmechanisms designed to control articulation and operation of the endeffector 604.

FIG. 7 illustrates the potential degrees of freedom in which the wrist606 may be able to articulate (pivot). The degrees of freedom of thewrist 606 are represented by three translational variables (i.e., surge,heave, and sway), and by three rotational variables (i.e., Euler anglesor roll, pitch, and yaw). The translational and rotational variablesdescribe the position and orientation of a component of a surgicalsystem (e.g., the end effector 604) with respect to a given referenceCartesian frame. As depicted in FIG. 7, “surge” refers to forward andbackward translational movement, “heave” refers to translationalmovement up and down, and “sway” refers to translational movement leftand right. With regard to the rotational terms, “roll” refers to tiltingside to side, “pitch” refers to tilting forward and backward, and “yaw”refers to turning left and right.

The pivoting motion can include pitch movement about a first axis of thewrist 606 (e.g., X-axis), yaw movement about a second axis of the wrist606 (e.g., Y-axis), and combinations thereof to allow for 360°rotational movement of the end effector 604 about the wrist 606. Inother applications, the pivoting motion can be limited to movement in asingle plane, e.g., only pitch movement about the first axis of thewrist 606 or only yaw movement about the second axis of the wrist 606,such that the end effector 604 moves only in a single plane. SURGE

Referring again to FIG. 6, the surgical tool 600 includes a plurality ofdrive cables (generally obscured in FIG. 6) that form part of a cabledriven motion system configured to facilitate operation and articulation(movement) of the end effector 604 relative to the shaft 602. Forexample, selectively moving the drive cables can actuate the endeffector 604 and thereby collapse the jaw members 610, 612 toward eachother. Moreover, moving the drive cables can also move the end effector604 between an unarticulated position and an articulated position. Theend effector 604 is depicted in FIG. 6 in the unarticulated positionwhere a longitudinal axis A₂ of the end effector 604 is substantiallyaligned with the longitudinal axis A₁ of the shaft 602, such that theend effector 604 is at a substantially zero angle relative to the shaft602. In the articulated position, the longitudinal axes A₁, A₂ would beangularly offset from each other such that the end effector 604 is at anon-zero angle relative to the shaft 602.

FIG. 8 is an enlarged isometric view of the distal end of the surgicaltool 600 of FIG. 6. More specifically, FIG. 8 depicts an enlarged andpartially exploded view of the end effector 604 and the wrist 606. Thewrist 606 operatively couples the end effector 604 to the shaft 602. Toaccomplish this, the wrist 606 includes a distal clevis 802 a, aproximal clevis 802 b, and a spacer 803 interposing the distal andproximal clevises 802 a,b. The end effector 604 is coupled to the distalclevis 802 a and the distal clevis 802 a is rotatably mounted to thespacer 803 at a first axle 804 a. The spacer 803 is rotatably mounted tothe proximal clevis 802 b at a second axle 804 b and the proximal clevis802 b is coupled to a distal end 806 of the shaft 602.

The wrist 606 provides a first pivot axis P₁ that extends through thefirst axle 804 a and a second pivot axis P₂ that extends through thesecond axle 804 b. The first pivot axis P₁ is substantiallyperpendicular (orthogonal) to the longitudinal axis A₂ of the endeffector 604, and the second pivot axis P₂ is substantiallyperpendicular (orthogonal) to both the longitudinal axis A₂ and thefirst pivot axis P₁. Movement about the first pivot axis P₁ provides“pitch” articulation of the end effector 604, and movement about thesecond pivot axis P₂ provides “yaw” articulation of the end effector604.

A plurality of drive cables 808 extend longitudinally within the shaft602 and pass through the wrist 106 to be operatively coupled to the endeffector 604. The drive cables 808 form part of the cable driven motionsystem briefly described above, and may be referred to and otherwisecharacterized as cables, bands, lines, cords, wires, ropes, strings,twisted strings, elongate members, etc. The drive cables 808 can be madefrom a variety of materials including, but not limited to, metal (e.g.,tungsten, stainless steel, etc.) or a polymer.

The drive cables 808 extend proximally from the end effector 604 to thedrive housing 608 (FIG. 6) where they are operatively coupled to variousactuation mechanisms or devices housed (contained) therein to facilitatelongitudinal movement (translation) of the drive cables 808. Selectiveactuation of the drive cables 808 causes the end effector 604 toarticulate (pivot) relative to the shaft 602. Moving a given drive cable808 constitutes applying tension (i.e., pull force) to the given drivecable 808 in a proximal direction, which causes the given drive cable808 to translate and thereby cause the end effector 604 to move(articulate) relative to the shaft 602.

One or more actuation cables 810, shown as first actuation cables 810 aand second actuation cables 810 b, may also extend longitudinally withinthe shaft 602 and pass through the wrist 106 to be operatively coupledto the end effector 604. The actuation cables 810 a,b may be similar tothe drive cables 808 and also form part of the cable driven motionsystem. Selectively actuating the actuation cables 810 a,b causes theend effector 604 to actuate, such as collapsing the first and second jawmembers 610, 612 to crimp a surgical clip (not shown).

More specifically, the actuation cables 810 a,b may be operativelycoupled to a cam 812 that is slidably engageable with the jaw members610, 612. One or more pulleys 814 may be used to receive and redirectthe first actuation cables 810 a for engagement with the cam 812.Longitudinal movement of the first actuation cables 810 acorrespondingly moves the cam 812 distally relative to the jaw members610, 612. The distal end of the cam 812 includes a tapering recess orcamming channel 1204 formed therein for slidably receiving correspondingcam tracks 818 provided by the jaw members 610, 612. As the cam 812 isadvanced distally, the camming channel 1204 pushes (collapses) the jawmembers 610, 612 toward one another, thereby crimping a surgical clip(not shown) disposed therebetween. Actuation of the second actuationcables 810 b (one shown) pulls the cam 812 proximally, thereby allowingthe jaw members 610, 612 to open again to receive another surgical clip.

Although not expressly depicted in FIG. 8, an assembly including, forexample, a feedbar, a feeder shoe, and a clip track may be included ator near the end effector 604 to facilitate feeding surgical clips intothe jaw members 610, 612. In some embodiments, the feedbar (or aconnecting member) may be flexible and extend through the wrist 606.

FIG. 9 is a bottom view of the drive housing 608, according to one ormore embodiments. As illustrated, the drive housing 608 may include atool mounting interface 902 used to operatively couple the drive housing608 to a tool driver of a robotic manipulator. The tool mountinginterface 902 may mechanically, magnetically, and/or electrically couplethe drive housing 608 to a tool driver.

As illustrated, the interface 902 includes and supports a plurality ofdrive inputs, shown as drive inputs 906 a, 906 b, 906 c, 906 d, 906 e,and 906 f. Each drive input 906 a-f may comprise a rotatable discconfigured to align with and couple to a corresponding input actuator(not shown) of a tool driver. Moreover, each drive input 906 a-fprovides or defines one or more surface features 908 configured to alignwith mating features provided on the corresponding input actuator. Thesurface features 908 can include, for example, various protrusionsand/or indentations that facilitate a mating engagement.

In some embodiments, actuation of the first drive input 906 a maycontrol rotation of the elongate shaft 602 about its longitudinal axisA₁. Depending on the rotational actuation of the first drive input 906a, the elongate shaft 602 may be rotated clockwise or counter-clockwise.In some embodiments, selective actuation of the second and third driveinputs 906 b,c may cause movement (axial translation) of the actuationcables 810 a,b (FIG. 8), which causes the cam 812 (FIG. 8) to move andcrimp a surgical clip, as generally described above. In someembodiments, actuation of the fourth drive input 906 d feeds a surgicalclip into the jaw members 610, 612 (FIG. 8). In some embodiments,actuation of the fifth and sixth drive inputs 906 e,f causes movement(axial translation) of the drive cables 808 (FIG. 8), which results inarticulation of the end effector 604. Each of the drive inputs 906 a-fmay be actuated based on user inputs communicated to a tool drivercoupled to the interface 902, and the user inputs may be received via acomputer system incorporated into the robotic surgical system.

FIG. 10 is an isometric exposed view of the interior of the drivehousing 608, according to one or more embodiments. Several componentparts that may otherwise be contained within the drive housing 608 arenot shown in FIG. 10 to enable discussion of the depicted componentparts.

As illustrated, the drive housing 608 contains a first capstan 1002 a,which is operatively coupled to or extends from the first drive input906 a (FIG. 9) such that actuation of the first drive input 906 aresults in rotation of the first capstan 1002 a. A helical drive gear1004 is coupled to or forms part of the first capstan 1002 a and isconfigured to mesh and interact with a driven gear 1006 operativelycoupled to the shaft 602 such that rotation of the driven gear 1006correspondingly rotates the shaft 602. Accordingly, rotation of thehelical drive gear 1004 (via actuation of the first drive input 906 a ofFIG. 9) will drive the driven gear 1006 and thereby control rotation ofthe elongate shaft 602 about the longitudinal axis A₁.

The drive housing 608 also includes second and third capstans 1002 b and1002 c operatively coupled to or extending from the second and thirddrive inputs 906 b,c (FIG. 9), respectively, such that actuation of thesecond and third drive inputs 906 b,c results in rotation of the secondand third capstans 1002 b,c. The second and third capstans 1002 b,ccomprise capstan pulleys operatively coupled to the actuation cables 810a,b (FIG. 8) such that rotation of a given capstan 1002 b,c actuates(longitudinally moves) a corresponding one of the actuation cables 810a,b. Accordingly, selective rotation of the second and third capstans1002 b,c via actuation of the second and third drive inputs 906 b,c,respectively, will cause movement (axial translation) of the actuationcables 810 a,b, which causes the cam 812 (FIG. 8) to move and crimp asurgical clip.

The drive housing 608 further includes a fourth capstan 1002 d, which isoperatively coupled to or extends from the fourth drive input 906 d(FIG. 9) such that actuation of the fourth drive input 906 d results inrotation of the fourth capstan 1002 d. A spur gear 1008 is coupled to orforms part of the fourth capstan 1002 d and is configured to mesh andinteract with a rack gear (not shown) also contained within the drivehousing 608. The rack gear may be operatively coupled to a feedbar (oranother connecting member) which facilitates operation of a feeder shoeand associated clip track to feed surgical clips into the jaw members610, 612 (FIGS. 6 and 8). Accordingly, rotation of the spur gear 1008(via actuation of the fourth drive input 906 d) will control the feedbarand thereby control loading of surgical clips into the jaw members 610,612 as desired.

The drive housing 608 further contains or houses fifth and sixthcapstans 1002 e and 1002 f operatively coupled to or extending from thefifth and sixth drive inputs 906 e,f (FIG. 9), respectively, such thatactuation of the fifth and sixth drive inputs 906 e,f results inrotation of the fifth and sixth capstans 1002 e,f. The fifth and sixthcapstans 1002 e,f comprise capstan pulleys operatively coupled to thedrive cables 808 (FIG. 8) such that rotation of a given capstan 1002 e,factuates (longitudinally moves) a corresponding one of the actuationcables 808. Accordingly, selective rotation of the fifth and sixthcapstans 1002 e,f via actuation of the fifth and sixth drive inputs 906e,f, respectively, will cause movement (axial translation) of the drivecables 808 and thereby articulate (pivot) the end effector 604 relativeto the shaft 602.

The surgical tools 200, 600 described herein above may incorporate andfacilitate the principles of the present disclosure in improving feedingand/or forming of surgical clips in robotic or non-robotic clipappliers. Moreover, it is contemplated herein to combine some or all ofthe features of the surgical tools 200, 600 to facilitate operation ofthe embodiments described below. Accordingly, example surgical toolsthat may incorporate the principles of the present disclosure mayinclude geared actuators, capstan pulley and cable actuators, or anycombination thereof, without departing from the scope of the disclosure.

FIGS. 11A-11C are partial cross-sectional top views of a distal portionof an example end effector 1102, according to one or more embodiments ofthe present disclosure. The end effector 1102 may be similar in somerespects to the end effectors 204 and 604 of FIGS. 2 and 6,respectively. For instance, similar to the end effectors 204, 604, theend effector 1102 may be incorporated into either or both of thesurgical tools 200, 600 described herein above. Moreover, the endeffector 1102 may comprise a clip applier having opposed jaw members1104 and 1106 actuatable to collapse toward one another to crimp asurgical clip. As described herein, the end effector 1102 mayincorporate various component parts and actuatable mechanisms orfeatures that facilitate the feeding of surgical clips into the jawmembers 1104, 1106 and collapsing the jaw members 1104, 1106 to crimpthe surgical clip when desired.

FIGS. 11A-11C illustrate progressive views of the end effector 1102during example operation of feeding the surgical clips 1114 into the jawmembers 1104, 1106. Referring first to FIG. 11A, the end effector 1102includes an elongate body 1108 having a proximal end 1110 a and a distalend 1110 b. In some embodiments, the body 1108 may be the same as orsimilar to the outer tube 402 of FIG. 4. In other embodiments, however,the body 1108 may comprise an independent structure from the outer tube402. Various component parts and mechanisms of the end effector 1102 arepositioned within the inside or interior of the body 1108. The jawmembers 1104, 1106 extend out of or otherwise protrude from the distalend 1110 b of the body 1108. In at least one embodiment, the proximalend 1110 a may be operatively coupled to an elongate shaft of a surgicaltool, such as the shaft 202 of the surgical tool 200 of FIG. 2. In otherembodiments, however, the proximal end 1110 a may be operatively coupledto an articulable wrist joint, such as the wrist 606 of the surgicaltool 600 of FIG. 6. In such embodiments, the surgical clips 1114 arestored distal to the wrist within the end effector 1102.

The end effector 1102 also includes a clip track 1112. In someembodiments, the body 1108 defines or otherwise provides the clip track1112. In other embodiments, however, the clip track 1112 may comprise aseparate structural component that is removably positioned within thebody 1108. The clip track 1112 may be configured to contain andotherwise house one or more surgical clips 1114, and preferably aplurality of surgical clips 1114 arranged in series. While four surgicalclips 1114 are depicted in FIG. 11A, more or less than four may beemployed, without departing from the scope of the disclosure.

Each surgical clip 1114 includes a crown 1116 (alternately referred toas an “apex”) and a pair of legs 1118 extending longitudinally from thecrown 1116. The legs of conventional surgical clips typically convergetoward one another. Converging legs, however, reduce the clip-to-jawretention capability and also reduce allowable tip width between the jawmembers 1104, 1106, which correspondingly limits the size of tissue thatcan be treated with the end effector 1102. Moreover, with convergingclip legs, the surgical clips are commonly arranged with the legs of themore proximal surgical clips engaging the crown of the more distalsurgical clips, which maximizes the axial space accommodated by thesurgical clips in the clip track and thereby reduces the number of clipsthat can be stored for use.

In contrast, the surgical clips 1114 described herein may becharacterized as “wide-aperture” surgical clips. More specifically, thelegs 1118 of the surgical clips 1114 diverge from each other andotherwise open to a diverging opening angle 1120 relative to oneanother. The diverging opening angle 1120 may comprise any angle thatresults in the legs 1118 diverging from each other as extending from thecrown 1116. The diverging opening angle 1120 may range between about 5°and about 35°, but could be as large as 45° or more, depending on thedesign constraints of the clip track 1112.

The diverging opening angle 1120 may prove advantageous in allowing thesurgical clips 1114 to be positioned within the clip track 1112 in apartially or fully nested configuration, where the legs 1118 of the moreproximal surgical clips 1114 extend past the crown 1116 and partiallyoverlap the legs 1118 of the more distal surgical clips 1114.Consequently, the more distal surgical clips 1114 are received by andpartially nested within the more proximal distal clips 1114. As will beappreciated, this nested configuration allows the clip track 1112 toaccommodate a higher number of surgical clips 1114 within the same axialconstraints (dimensions), which provides a user with additional surgicalclips 1114 for use.

Surgical clips 1114 with legs 1118 that diverge at the diverging openingangle 1120 are referred to herein as being in a first or “wide” state.To be received between the jaw members 1104, 1106 for crimping, however,the surgical clips 1114 must be transitioned from the wide state to asecond or “tissue-ready” state. To accomplish this, the end effector1102 may include a pre-forming region 1122 configured to receive widestate surgical clips 1114 and reduce (minimize) the diverging openingangle 1120 as the surgical clips 1114 advance distally such that tissueready surgical clips 1114 are discharged into the jaw members 1104,1106. The surgical clips 1114 may be plastically or elastically deformedas they traverse the pre-forming region 1122 in the distal direction.The surgical clips 1114 are fully formed when the jaw members 1104, 1106collapse and crimp the surgical clips 1114.

As used herein, “minimizing” the diverging opening angle 1120 refers todecreasing the diverging opening angle 1120 to an angular magnitudewhere the surgical clip 1114 can be received in between the jaw members1104, 1106. In at least one embodiment, “minimizing” the divergingopening angle 1120 refers to eliminating the diverging opening angle1120 such that the legs 1118 extend parallel or substantially parallelto one another.

The pre-forming region 1122 generally comprises opposed structuralsurfaces that converge or taper toward one another in the distaldirection. In some embodiments, the pre-forming region 1122 may bedefined by the body 1108. In other embodiments, however, the pre-formingregion 1122 may be defined or otherwise provided by the clip track 1112.

The distal end of the pre-forming region 1122 may be aligned with andarranged to feed tissue-ready surgical clips 1114 into the jaw members1104, 1106. In at least one embodiment, each jaw member 1104, 1106includes a channel or groove 1124 formed on opposed inner surfacesthereof for receiving a distal-most surgical clip, referenced herein as1114 a. In such embodiments, the grooves 1124 may prove advantageous inhelping to capture and maintain the distal-most surgical clip 1114 a ina known and secure position between the jaw members 1104, 1106. In otherembodiments, however, the grooves 1124 may be omitted and thedistal-most surgical clip 1114 a may instead be captured or held betweenthe jaw members 1104, 1106 via an interference fit or the like.

The end effector 1102 may further include a feedbar 1126, a retentionmember 1128, and a feeder shoe 1130. The feedbar 1126 may be configuredto engage and move the distal-most surgical clip 1114 a through thepre-forming region 1122 and deliver the distal-most surgical clip 1114in its tissue-ready state to the jaw members 1104, 1106. In someembodiments, the feedbar 1126 may extend to the end effector 1102 from adrive housing (e.g., the drive housings 206, 606 of FIGS. 2 and 6,respectively). At the drive housing, the feedbar 1126 may be operativelycoupled to an actuating mechanism or device configured to causelongitudinal translation of the feedbar 1126. In one embodiment, forexample, the feedbar 1126 may be operatively coupled to and otherwiseextend from one or more translatable driven gears, such as the first andsecond driven gears 504 a,b of FIG. 5. In embodiments with anarticulable wrist, the feedbar 1126 may be made of a flexible materialand extend through the wrist. Alternatively, the feedbar 1126 may beoperatively coupled to a cable-driven worm gear arranged distal to thewrist and the associated drive cable(s) that moves the worm gear extendthrough the wrist.

The retention member 1128 may be configured to engage the distal-mostsurgical clip 1114 a and thereby prevent the stacked surgical clips 1114from advancing distally until the distal-most surgical clip 1114 a isacted upon by the feedbar 1126. In some embodiments, the retentionmember 1128 may comprise a passive biasing device, such as a gate springor the like. In such embodiments, the spring force of the retentionmember 1128 may be sufficient to retain the stacked surgical clips 1114in place, but may be overcome when the feedbar 1126 applies an axialload on the distal-most surgical clip 1114 a. In other embodiments,however, the retention member 1128 may comprise a post or the likeoperatively coupled to an actuatable device or mechanism. The post maybe configured to retain the stacked surgical clips 1114 in place andrelease the distal-most surgical clip 1114 a when actuated. In suchembodiments, the retention member 1128 may be actuated and otherwisedriven using any of the actuation components associated with the drivehousings 206, 606 (FIGS. 2 and 6, respectively) discussed herein, oralternatively may be operatively coupled to a cable-driven worm gear orthe like arranged near the end effector 1102.

The feeder shoe 1130 may be configured to apply an axial load in thedistal direction on the surgical clips 1114 positioned within the cliptrack 1112. The axial load helps maintain proper positioning andsequential feeding of the surgical clips 1114. In some embodiments, asillustrated, the feeder shoe 1130 may include a compression spring 1132that engages a proximal end of the feeder shoe 1130 to provide a passiveand constant axial load on the surgical clips 1114. In otherembodiments, however, the feeder shoe 1130 may include or comprise anactuatable device or mechanism that selectively supplies the axial load.In such embodiments, the feeder shoe 1130 may apply the axial load onlyto advance the surgical clips 1114 a predetermined distance within theclip track 1112.

With additional reference to FIGS. 11B and 11C, example operation offeeding the distal-most surgical clip 1114 a into the jaw members 1104,1106 is now provided. In FIG. 11A, the retention member 1128 is shownengaging the distal-most surgical clip 1114 a and thereby preventing thestacked surgical clips 1114 from advancing distally until acted upon bythe feedbar 1126. In some embodiments, as illustrated, the retentionmember 1128 may engage the distal-most surgical clip 1114 a at or nearthe crown 1116. In other embodiments, however, the retention member 1128may engage the distal-most surgical clip 1114 a at any other location ormay alternatively engage the entire stack of surgical clips 1114,without departing from the scope of the disclosure.

To advance the distal-most surgical clip 1114 a toward the jaw members1104, 1106, the feedbar 1126 may be advanced distally until engaging thedistal-most surgical clip 1114 a. In some embodiments, as illustrated,the feedbar 1126 may engage the distal-most surgical clip 1114 a at ornear the crown 1116, but could alternatively engage the distal-mostsurgical clip 1114 a at any other location. In embodiments where theretention member 1128 comprises a passive spring, an axial load providedby the feedbar 1126 on the distal-most surgical clip 1114 a may overcomethe spring force of the retention member 1128 to bypass the retentionmember 1128 and thereby move the distal-most surgical clip 1114 adistally. In other embodiments, however, the retention member 1128 maybe actuated or otherwise moved to allow the feedbar 1126 to convey thedistal-most surgical clip 1114 a distally past the retention member1128.

In FIG. 11B, the distal-most surgical clip 1114 a is shown beingadvanced distally by the feedbar 1126 past the retention member 1128 andinto the pre-forming region 1122. Once the distal-most surgical clip1114 a bypasses the retention member 1128, the feeder shoe 1130 maydistally advance the remaining surgical clips 1114 positioned within theclip track 1112 until a penultimate surgical clip 1114 b is received andretained by the retention member 1128. In some embodiments, thecompression spring 1132 may provide the required axial load to move thesurgical clips 1114 distally, but in other embodiments, the feeder shoe1130 may be actuated to advance the surgical clips 1114 a predetermineddistance.

As the distal-most surgical clip 1114 a is advanced distally, the legs1118 are received by and slidably engage the inner walls of thepre-forming region 1122. The distally converging and rampedconfiguration of the pre-forming region 1122 transitions the distal-mostsurgical clip 1114 a from the first or “wide” state to the second or“tissue-ready” state in preparation for being received by the jawmembers 1104, 1106. As it traverses the pre-forming region 1122, thedistal-most surgical clip 1114 a plastically or elastically deforms asthe diverging opening angle 1120 (FIG. 11A) of the legs 1118 is reducedor minimized.

In FIG. 11C, the distal-most surgical clip 1114 a is shown as havingtraversed the pre-forming region 1122 and being received within the jawmembers 1104, 1106. In embodiments including the grooves 1124 defined oneach jaw member 1104, 1106, the legs 1118 may spring outward and seatthemselves within the grooves 1124, which may help retain the surgicalclip 1114 in place. Otherwise, the distal-most surgical clip 1114 may beretained between the jaw members 1104, 1106 via an interference. At thispoint, the jaw members 1104, 1106 may be actuated to collapse or closeand thereby crimp the distal-most surgical clip 1114 a therebetween. Asused herein, “actuating” the jaw members 1104, 1106 refers to themechanical process of collapsing or closing the jaw members 1104, 1106.

FIGS. 12A-12C are partial cross-sectional side views of the end effector1102 of FIGS. 11A-11C. Similar to FIGS. 11A-11C, FIGS. 12A-12C provideprogressive views of the end effector 1102 during example operation offeeding the distal-most surgical clip 1114 a into the jaw members 1104,1106.

Referring first to FIG. 12A, the end effector 1102 may further include acam 1202 that is slidably engageable with the jaw members 1104, 1106. Inthe illustrated embodiment, the cam 1202 is arranged within the body1108, but can alternatively be arranged external to the body 1108,without departing from the scope of the disclosure. The cam 1202 may bemovable relative to the body 1108 and, more importantly, to the jawmembers 1104, 1106. The distal end of the cam 1202 includes a taperingrecess or camming channel 1204 formed therein for slidably receivingcorresponding cam tracks 1206 provided by each jaw member 1104, 1106. Asthe cam 1202 is actuated and advanced distally, the camming channel 1204slidably engages the cam tracks 1206 provided and thereby pushes(collapses) the jaw members 1104, 1106 toward one another.

As illustrated, the surgical clips 1114 are shown arranged within theclip track 1112 with the distal-most surgical clip 1114 a at leastpartially nested within the penultimate surgical clip 1114 b. Moreover,the retention member 1128 is depicted as engaging the distal-mostsurgical clip 1114 a to prevent the stacked surgical clips 1114 fromadvancing distally. In the illustrated embodiment, the retention member1128 is depicted as a passive gate spring that engages the distal-mostsurgical clip 1114 a at or near its crown 1116. The retention member1128 exhibits a spring force sufficient to retain the stacked surgicalclips 1114 in place until the distal-most surgical clip 1114 a is actedupon by the feedbar 1126.

In some embodiments, the feedbar 1126 may provide or otherwise define aprotrusion 1208 at its distal end configured to mate with a groove 1210defined in the clip track 1112 or the body 1108. Applying an axial loadin the distal direction on the feedbar 1126 disengages the protrusion1208 from the groove 1210, following which the feedbar 1126 may beadvanced distally until engaging the distal-most surgical clip 1114 a.

In FIG. 12B, the distal-most surgical clip 1114 a is shown beingadvanced distally by the feedbar 1126 within the clip track 1112 andpast the retention member 1128. More specifically, once the protrusion1208 exits the groove 1210, the protrusion 1208 slidably engages theinner wall of the clip track 1112 and causes the distal end of thefeedbar 1126 to flex downward and into engagement with the distal-mostsurgical clip 1114 a. In the illustrated embodiment, the feedbar 1126applies an axial load on the distal-most surgical clip 1114 a thatcauses the retention member 1128 to flex downward and out of the way. Asthe distal-most surgical clip 1114 a is advanced distally, the legs 1118are received by and slidably engage the inner (lateral) walls of thepre-forming region 1122, which transitions the distal-most surgical clip1114 a from the wide state to the tissue-ready state in preparation forbeing received by the jaw members 1104, 1106.

In FIG. 12C, after the distal-most surgical clip 1114 a bypasses theretention member 1128, the feeder shoe 1130 (FIGS. 11A-11C) may operateto advance the remaining surgical clips 1114 distally within the cliptrack 1112 until the penultimate surgical clip 1114 b is received andretained by the retention member 1128. The distal-most surgical clip1114 a is shown in FIG. 12C as having traversed the pre-forming region1122 and advanced into the jaw members 1104, 1106. In embodimentsincluding the grooves 1124 defined on each jaw member 1104, 1106, thelegs 1118 may spring outward and seat themselves within the grooves1124. With the distal-most surgical clip 1114 a properly seated withinthe jaw members 1104, 1106, the cam 1202 may then be actuated tocollapse the jaw members 1104, 1106 and thereby crimp the distal-mostsurgical clip 1114 a therebetween, as generally described above.

FIGS. 13A-13E are partial cross-sectional top views of a distal portionof another example end effector 1302, according to one or moreembodiments of the present disclosure. The end effector 1302 may besimilar in some respects to the end effector 1102 of FIGS. 11A-11C and,therefore, may be best understood with reference thereto, where likenumerals will correspond to like components not described again indetail. FIGS. 13A-13E illustrate progressive views of the end effector1302 during example operation of feeding surgical clips 1114 into thejaw members 1104, 1106 for crimping.

Referring first to FIG. 13A, the end effector 1302 includes the elongatebody 1108 and the jaw members 1104, 1106 extend out of or otherwiseprotrude from the distal end 1110 b thereof. A clip track 1303 isarranged within the body 1108 and is configured to contain and otherwisehouse the surgical clips 1114. While six surgical clips 1114 aredepicted in FIG. 13A, more or less than six may be employed, withoutdeparting from the scope of the disclosure.

As with the prior embodiment, the legs 1118 of the surgical clips 1114diverge from each other at the diverging opening angle 1120. However,the diverging opening angle 1120 depicted in FIG. 13A is greater thanthe diverging opening angle 1120 of FIG. 11A. Consequently, moresurgical clips 1114 may be accommodated within the limited axialconstraints (dimensions) of the clip track 1303 as the surgical clips1114 are able to be positioned in a more nested configuration ascompared with the surgical clips 1114 of FIGS. 11A-11C.

To transition the distal-most surgical clip 1114 a from the first or“wide” state to the second or “tissue-ready” state, the distal-mostsurgical clip 1114 a may be advanced into a pre-forming region 1304configured to reduce (minimize) the diverging opening angle 1120 suchthat the distal-most surgical clip 1114 a is provided to the jaw members1104, 1106 in its tissue-ready state. As illustrated, the pre-formingregion 1304 may be provided or otherwise defined by the jaw members1104, 1106. More specifically, the pre-forming region 1304 may bearranged proximal to the distal end of the jaw members 1104, 1106 andmay be characterized as or otherwise form part of a first stage thatplastically or elastically deforms the distal-most surgical clip 1114 afrom the wide state to the tissue-ready state. The distal-most surgicalclip 1114 a is then advanced distally into the jaw members 1104, 1106and to a second stage where it may be crimped when the jaw members 1104,1106 collapse (close) toward one another. The pre-forming region 1304may be aligned with and arranged to feed tissue-ready surgical clips1114 into the jaw members 1104, 1106, each of which may include thechannel or groove 1124 formed on opposed inner surfaces thereof.

The end effector 1302 further includes a feedbar 1306, which maycomprise a two-stage feedbar configured to simultaneously engage andmove the distal-most surgical clip 1114 a and the penultimate surgicalclip 1114 b. To accomplish this, the feedbar 1306 provides a firstengagement member 1308 a and a second engagement member 1308 b,alternately referred to as distal and proximal teeth, respectively. Asillustrated, the first engagement member 1308 a is located at the distalend of the feedbar 1306 and the second engagement member 1308 b islocated proximal to the first engagement member 1308 a and axiallyoffset therefrom a predetermined distance. As described below, the firstand second engagement members 1308 a,b may be configured tocooperatively and sequentially advance the distal-most and penultimatesurgical clips 1114 a,b into the pre-forming region 1304 and the jawmembers 1104, 1106 in a two stage process.

The end effector 1302 may also include the retention member 1128, andthe feeder shoe 1130, which operate as generally described above.

With additional reference to FIGS. 13B-13E, example operation of feedingthe surgical clips 1114 into the jaw members 1104, 1106 is now provided.In FIG. 13A, the retention member 1128 is shown engaging the distal-mostsurgical clip 1114 a and thereby preventing the stacked surgical clips1114 from advancing distally. To distally advance the distal-mostsurgical clip 1114 a, the feedbar 1306 may be advanced until the firstengagement member 1308 a engages the distal-most surgical clip 1114 a.In embodiments where the retention member 1128 comprises a passivespring, an axial load provided by the feedbar 1306 on the distal-mostsurgical clip 1114 a may overcome the spring force of the retentionmember 1128 to move the distal-most surgical clip 1114 a distally andinto the pre-forming region 1304. In other embodiments, however, theretention member 1128 may be actuated or otherwise moved to allow thefeedbar 1306 to distally move the distal-most surgical clip 1114 a.

In FIG. 13B, the distal-most surgical clip 1114 a is shown as havingadvanced distally past the retention member 1128 and into thepre-forming region 1304. Once the distal-most surgical clip 1114 abypasses the retention member 1128, the feeder shoe 1130 may operate todistally advance the remaining surgical clips 1114 positioned within theclip track 1303 until the penultimate surgical clip 1114 b is receivedand retained by the retention member 1128. In some embodiments,advancing the distal-most surgical clip 1114 a into the pre-formingregion 1304 may also advance the second engagement member 1308 b of thefeedbar 1306 into engagement with the penultimate surgical clip 1114 bas retained by the retention member 1128.

The distal-most surgical clip 1114 a is received into the pre-formingregion 1304 in its wide state. To transition the distal-most surgicalclip 1114 a to its tissue-ready state, the jaw members 1104, 1106 may beactuated and otherwise collapsed toward each other. In some embodiments,this may be accomplished through the use of a cam (e.g., the cam 1202 ofFIGS. 12A-12C; see also FIGS. 14A-14C) that is slidably engageable withthe jaw members 1104, 1106 and, more particularly, with correspondingcam tracks 1310 provided by the jaw members 1104, 1106. As the cam isadvanced distally relative to the jaw members 1104, 1106, the camengages the cam tracks 1310 and correspondingly pushes (collapses) thejaw members 1104, 1106 toward one another.

In FIG. 13C, the jaw members 1104, 1106 are depicted as having collapsedor closed toward one another. As the jaw members 1104, 1106 close, thedistal-most surgical clip 1114 a is partially crimped within thepre-forming region 1304 and otherwise plastically or elasticallytransitioned from the wide state to the tissue-ready state. The jawmembers 1104, 1106 may then be re-opened to receive the distal-mostsurgical clip 1114 a in its tissue-ready state. Accordingly, asillustrated, when the jaw members 1104, 1106 are actuated for the firsttime, the pre-forming region 1304 provides a cavity or space thatdeforms the distal-most surgical clip 1114 a into its tissue-readystate.

In FIG. 13D, the distal-most surgical clip 1114 a is shown as havingtraversed the pre-forming region 1304 and received by the jaw members1104, 1106 as the feedbar 1306 advances distally. In embodimentsincluding the grooves 1124 defined on each jaw member 1104, 1106, thelegs 1118 of the distal-most surgical clip 1114 a may spring outward andseat themselves within the grooves 1124, which helps retain thedistal-most surgical clip 1114 a in place.

As the feedbar 1306 conveys the distal-most surgical clip 1114 a intothe jaw members 1104, 1106, the penultimate surgical clip 1114 b mayalso be simultaneously conveyed into the pre-forming region 1304 asengaged by the second engagement member 1308 b. More specifically, thepenultimate surgical clip 1114 b may be advanced distally by advancingthe feedbar 1306 and providing an axial load on the penultimate surgicalclip 1114 b at the second engagement member 1308 b. The axial loadtransferred to the penultimate surgical clip 1114 b may overcome thespring force of the retention member 1128 to move the penultimatesurgical clip 1114 b distally and into the pre-forming region 1304. Inother embodiments, however, the retention member 1128 may be actuated orotherwise moved to allow the feedbar 1306 to distally move thepenultimate surgical clip 1114 b.

After the penultimate surgical clip 1114 b bypasses the retention member1128, the feeder shoe 1130 may operate to advance the remaining surgicalclips 1114 distally within the clip track 1303 until an antepenultimatesurgical clip 1114 c is received and retained by the retention member1128.

The penultimate surgical clip 1114 b is received into the pre-formingregion 1304 in its wide state, and may be transitioned to itstissue-ready state in the same process described above to transition thedistal-most surgical clip 1114 a to the tissue-ready state. Collapsingor closing the jaw members 1104, 1106 a second time, however, will alsocrimp the distal-most surgical clip 1114 a received between the jawmembers 1104, 1106.

In FIG. 13E, the jaw members 1104, 1106 are depicted as having collapsedor closed toward one another a second time. As the jaw members 1104,1106 close for the second time, the distal-most surgical clip 1114 a iscrimped between the jaw members 1104, 1106 and the penultimate surgicalclip 1114 b is simultaneously partially crimped within the pre-formingregion 1304 and otherwise transitioned from the wide state to thetissue-ready state. At this point, the jaw members 1104, 1106 may thenbe re-opened and the penultimate surgical clip 1114 b may be advanceddistally to be received by the jaw members 1104, 1106. Prior to closingthe jaw members 1104, 1106 the second time, the feedbar 1306 may beretracted to engage the first engagement member 1308 a on thepenultimate surgical clip 1114 b, and the second engagement member 1308b may be engaged with the antepenultimate surgical clip 1114 c.

Accordingly, to operate the end effector 1302, a user may be required to“prime” the device by advancing surgical clips 1114 twice prior to beingable to crimp the distal-most surgical clip 1114 a between the jawmembers 1104, 1106. Once properly primed, however, the end effector 1302will function by crimping the distal-most surgical clip 1114 a each timethe device is fired, and the penultimate and antepenultimate surgicalclips 1114 b,c are automatically advanced and fed through the sameprocess.

FIGS. 14A-14C are partial cross-sectional side views of the end effector1302 of FIGS. 13A-13E. Similar to FIGS. 13A-13E, FIGS. 14A-14C provideprogressive views of the end effector 1302 during example operation offeeding the surgical clips 1114 into the jaw members 1104, 1106 forforming and crimping in the two-stage process.

Referring first to FIG. 14A, the end effector 1302 may further includethe cam 1202 that is slidably engageable with the jaw members 1104,1106. Again, the cam 1202 may be arranged within the body 1108, but canalternatively be arranged external to the body 1108, and the distal endof the cam 1202 includes the tapering recess or camming channel 1204formed therein for slidably receiving the corresponding cam tracks 1310provided by the jaw members 1104, 1106. As the cam 1202 is actuated andadvanced distally, the camming channel 1204 slidably engages the camtracks 1310 and thereby pushes (collapses) the jaw members 1104, 1106toward one another and toward a closed position.

As illustrated, the surgical clips 1114 are shown arranged within theclip track 1303 and at least partially nested within each other, asdescribed above. Moreover, the retention member 1128 is depicted asengaging the distal-most surgical clip 1114 a to prevent the stackedsurgical clips 1114 from further advancing distally. In the illustratedembodiment, the retention member 1128 is depicted as a passive gatespring that engages the distal-most surgical clip 1114 a. The retentionmember 1128 exhibits a spring force sufficient to retain the stackedsurgical clips 1114 in place until the distal-most surgical clip 1114 ais acted upon by the feedbar 1306.

In some embodiments, the distal end of the clip track 1303 may provideor otherwise define a ramped portion 1402. The ramped portion 1402 maybe configured to reposition (elevate) the surgical clips 1114 to enablethe first and second engagement members 1308 a,b of the feedbar 1306 toengage and distally advance the surgical clips 1114 positioned on theramped portion 1402. The retention member 1128 may extend through theramped portion 1402 to retain the surgical clip 1114 positioned thereonand thereby retain the remaining surgical clips 1114 within the cliptrack 1303.

To advance the distal-most surgical clip 1114 a distally, the feedbar1306 may be advanced until the first engagement member 1308 a engagesthe distal-most surgical clip 1114 a, which is positioned on the rampedportion 1402. In the illustrated embodiment, the feedbar 1306 applies anaxial load that urges the distal-most surgical clip 1114 a against theretention member 1128, which flexes downward and out of the way, andthereby allows the distal-most surgical clip 1114 a to exit the cliptrack 1303 and enter the pre-forming region 1304.

In FIG. 14B, the distal-most surgical clip 1114 a is shown beingadvanced distally by the feedbar 1306 and into the pre-forming region1304. Once the distal-most surgical clip 1114 a bypasses the retentionmember 1128, the feeder shoe 1130 (FIGS. 13A-13E) distally advances theremaining surgical clips 1114 positioned within the clip track 1303until the penultimate surgical clip 1114 b is received and retained bythe retention member 1128. In at least one embodiment, advancing thedistal-most surgical clip 1114 a into the pre-forming region 1304 mayalso advance the second engagement member 1308 b of the feedbar 1306into engagement with the penultimate surgical clip 1114 b. In otherembodiments, however, the second engagement member 1308 b does notengage the penultimate surgical clip 1114 b when the distal-mostsurgical clip 1114 a is advanced into the pre-forming region 1304.

While in the pre-forming region 1304, the distal-most surgical clip 1114a may be transitioned from its wide state to its tissue-ready state. Asdiscussed above, this may be accomplished by actuating the cam 1202 tocollapse or close the jaw members 1104, 1106. As the cam 1202 isadvanced distally relative to the jaw members 1104, 1106, the cammingchannel 1204 engages the cam tracks 1310 and correspondingly pushes(collapses) the jaw members 1104, 1106 toward one another. As the jawmembers 1104, 1106 close, the distal-most surgical clip 1114 a ispartially crimped within the pre-forming region 1304 and otherwiseplastically or elastically transitioned from the wide state to thetissue-ready state. The jaw members 1104, 1106 may then be re-opened toreceive the tissue-ready distal-most surgical clip 1114 a.

In FIG. 14C, the distal-most surgical clip 1114 a is shown as havingtraversed the pre-forming region 1304 and advanced into the jaw members1104, 1106. In embodiments including the grooves 1124 defined on eachjaw member 1104, 1106, the legs 1118 may spring outward and seatthemselves within the grooves 1124.

As the feedbar 1306 conveys the distal-most surgical clip 1114 a intothe jaw members 1104, 1106, the penultimate surgical clip 1114 b issimultaneously conveyed into the pre-forming region 1304 as engaged bythe second engagement member 1308 b. Applying an axial load on thepenultimate surgical clip 1114 b at the second engagement member 1308 bmay overcome the spring force of the retention member 1128 to move thepenultimate surgical clip 1114 b distally and into the pre-formingregion 1304.

After the penultimate surgical clip 1114 b bypasses the retention member1128, the feeder shoe 1130 (FIGS. 13A-13E) may again operate to advancethe remaining surgical clips 1114 distally within the clip track 1303until an antepenultimate surgical clip 1114 c is received and retainedby the retention member 1128.

The penultimate surgical clip 1114 b is received into the pre-formingregion 1304 in its wide state, and may be transitioned to itstissue-ready state in the same process described above to transition thedistal-most surgical clip 1114 a to the tissue-ready state. Moreparticularly, the jaw members 1104, 1106 may once again be closedthrough operation of the cam 1202, which partially crimps thepenultimate surgical clip 1114 b within the pre-forming region 1304 andtransitions the penultimate surgical clip 1114 b from the wide state tothe tissue-ready state.

Collapsing or closing the jaw members 1104, 1106 the second time,however, will also crimp the distal-most surgical clip 1114 a receivedbetween the jaw members 1104, 1106. At this point, the jaw members 1104,1106 may then be re-opened and the penultimate surgical clip 1114 b maybe advanced distally to be received by the jaw members 1104, 1106. Priorto closing the jaw members 1104, 1106 the second time, the feedbar 1306may be retracted to engage the first engagement member 1308 a on thepenultimate surgical clip 1114 b, and the second engagement member 1308b may be engaged with the antepenultimate surgical clip 1114 c.

The foregoing operational cycle may be repeated to continue tosimultaneously pre-form and crimp surgical clips 1114 until the supplyof surgical clips 1114 is exhausted.

FIGS. 15A and 15B are partial cross-sectional top views of a distalportion of another example end effector 1502, according to one or moreembodiments of the present disclosure. The end effector 1502 may besimilar in some respects to the end effectors 1102 and 1302 of FIGS.11A-11C and 13A-13D, respectively, and therefore may be best understoodwith reference thereto, where like numerals will correspond to likecomponents not described again in detail. FIGS. 15A and 15B illustrateprogressive views of the end effector 1502 during example operation offeeding surgical clips 1114 into the jaw members 1104, 1106 forcrimping.

Referring first to FIG. 15A, the end effector 1502 includes the elongatebody 1108 and the jaw members 1104, 1106 extend out of or otherwiseprotrude from the distal end 1110 b of the body 1108. The end effector1502 further includes a clip track 1504 configured to contain andotherwise house the surgical clips 1114. In some embodiments, the body1108 defines or otherwise provides the clip track 1504. In otherembodiments, however, the clip track 1504 may comprise a separatestructural component that is removably positioned within the body 1108.Similar to the prior embodiments, the surgical clips 1114 may exhibitthe diverging opening angle 1120, which allows the surgical clips 1114to be arranged within the clip track 1504 in a generally nestedrelationship. While five surgical clips 1114 are depicted in FIG. 15A,more or less than five may be employed, without departing from the scopeof the disclosure.

The end effector 1502 may further include a pre-forming region 1506configured to receive and progressively transition the surgical clips1114 from the wide state to the tissue-ready state. In some embodiments,the pre-forming region 1506 is defined by the body 1108, but mayalternatively be provided by the clip track 1504. In yet otherembodiments, the pre-forming region 1506 may comprise a separatestructural component that is removably positioned within the body 1108.As illustrated, the pre-forming region 1506 may comprise opposed ramped(angled) surfaces 1508 configured to successively reduce (minimize) thediverging opening angle 1120 of the surgical clips 1114 as they areadvanced distally toward the jaw members 1104, 1106. The surgical clips1114 may be plastically or elastically deformed as they traverse thepre-forming region 1506 in the distal direction.

The end effector 1502 further includes a feeder shoe 1510 configured toapply an axial load in the distal direction on the surgical clips 1114positioned within the clip track 1504. The axial load forces thesurgical clips 1114 through the pre-forming region 1506 to transitionthe surgical clips 1114 from wide to tissue-ready states. In someembodiments, as illustrated, the feeder shoe 1510 may include acompression spring 1512 that engages a proximal end of the feeder shoe1510 to provide a passive and constant axial load on the surgical clips1114. The spring force of the compression spring 1512 may be sufficientto force the surgical clips 1114 through the pre-forming region 1506until the last surgical clip 1114 is progressively and properlytransitioned to the tissue-ready state. In other embodiments, however,the feeder shoe 1510 may include or comprise an actuatable device ormechanism that selectively supplies the axial load. In such embodiments,the feeder shoe 1510 may apply the axial load only to advance thesurgical clips 1114 a predetermined distance within the clip track 1504,and thereby progressively advance the surgical clips 1114 through thepre-forming region 1506.

A feedbar 1514 may be included and configured to engage and move thedistal-most surgical clip 1114 a from the pre-forming region 1506 and tothe jaw members 1104, 1106. In some embodiments, the feedbar 1514 mayextend to the end effector 1502 from a drive housing (e.g., the drivehousings 206, 606 of FIGS. 2 and 6, respectively). At the drive housing,the feedbar 1514 may be operatively coupled to an actuating mechanism ordevice configured to cause longitudinal translation of the feedbar 1514.In one embodiment, for example, the feedbar 1514 may be operativelycoupled to and otherwise extend from one or more translatable drivengears, such as the first and second driven gears 504 a,b of FIG. 5. Inembodiments with an articulable wrist, the feedbar 1514 may be made of aflexible material and extend through the wrist. Alternatively, thefeedbar 1514 may be operatively coupled to a cable-driven worm geararranged distal to the wrist and the associated drive cable(s) thatmoves the worm gear extend through the wrist.

With additional reference to FIG. 15B, example operation of feeding thesurgical clips 1114 into the jaw members 1104, 1106 is now provided. InFIG. 15A, the feeder shoe 1510 is shown urging the stack of surgicalclips 1114 in the distal direction and through the pre-forming region1506. As they traverse the ramped surfaces 1508 of the pre-formingregion 1506, the surgical clips 1114 progressively transition from thewide state to the tissue-ready state. More specifically, the legs 1118of each surgical clip 1114 slidably engage the inner walls of thepre-forming region 1506 as the surgical clips 1114 advance distally. Thedistally converging and ramped configuration of the ramped surfaces 1508progressively reduces the diverging opening angle 1120 to producetissue-ready surgical clips at or near the distal end of the rampedsurfaces 1508.

As illustrated in FIG. 15A the distal-most surgical clip 1114 a has beentransitioned to the tissue-ready state. To advance the distal-mostsurgical clip 1114 a toward the jaw members 1104, 1106, the feedbar 1514may be advanced distally until engaging the distal-most surgical clip1114 a.

In FIG. 15B, the distal-most surgical clip 1114 a is shown as havingtraversed the pre-forming region 1506 and being advanced by the feedbar1514 to be received within the jaw members 1104, 1106. In embodimentsincluding the grooves 1124 defined on each jaw member 1104, 1106, thelegs 1118 may spring outward and seat themselves within the grooves1124, which may help retain the surgical clip 1114 in place. Otherwise,the distal-most surgical clip 1114 may be retained between the jawmembers 1104, 1106 via an interference. At this point, the jaw members1104, 1106 may be actuated to collapse or close and thereby crimp thedistal-most surgical clip 1114 a therebetween.

Once the distal-most surgical clip 1114 a is advanced out of thepre-forming region 1506, the feeder shoe 1510 may be configured todistally advance the remaining surgical clips 1114 positioned within theclip track 1504 and further into the pre-forming region 1506. As aresult, the penultimate surgical clip 1114 b may be fully transitionedfrom the wide state to the tissue-ready state and ready to be advanceddistally to the jaw members 1104, 1106 with the feedbar 1514.

The foregoing operational cycle may be repeated to continue toprogressively form tissue-ready surgical clips 1114 and advance thetissue-ready surgical clips 1114 to the jaw members 1104, 1106 to becrimped until the supply of surgical clips 1114 is exhausted.

Embodiments disclosed herein include:

A. An end effector for a surgical clip applier that includes an elongatebody, a clip track provided within the body and containing one or moresurgical clips, wherein each surgical clip includes a crown and a pairof legs extending longitudinally from the crown and diverging from eachother at a diverging opening angle, a pre-forming region provided withinthe body and arranged to receive and deform the one or more surgicalclips from a first state, where the pair of legs diverge at thediverging opening angle, and a second state, where the diverging openingangle is minimized, and first and second jaw members positioned at adistal end of the body and arranged to receive the one or more surgicalclips from the pre-forming region in the second state.

B. A method of operating an end effector of a surgical clip applier thatincludes positioning the end effector adjacent a patient for operation,the end effector including an elongate body, a clip track providedwithin the body and containing one or more surgical clips, wherein eachsurgical clip includes a crown and a pair of legs extendinglongitudinally from the crown and diverging from each other at adiverging opening angle, a pre-forming region provided within the bodyand arranged to receive the one or more surgical clips from the cliptrack, and first and second jaw members positioned at a distal end ofthe body and arranged to receive the one or more surgical clips from thepre-forming region. The method further including advancing a distal-mostsurgical clip of the one or more surgical clips from the clip track tothe pre-forming region, deforming the distal-most surgical clip in thepre-forming region from a first state, where the pair of legs of thedistal-most surgical clip diverge at the diverging opening angle, and asecond state, where the diverging opening angle is minimized, andadvancing the distal-most surgical clip from the pre-forming region tothe first and second jaw members in the second state.

C. A surgical clip applier that includes a drive housing, an elongateshaft that extends from the drive housing, and an end effector arrangedat a distal end of the elongate shaft. The end effector includes anelongate body, a clip track provided within the body and containing oneor more surgical clips, wherein each surgical clip includes a crown anda pair of legs extending longitudinally from the crown and divergingfrom each other at a diverging opening angle, a pre-forming regionprovided within the body and arranged to receive and deform the one ormore surgical clips from a first state, where the pair of legs divergeat the diverging opening angle, and a second state, where the divergingopening angle is minimized, and first and second jaw members positionedat a distal end of the body and arranged to receive the one or moresurgical clips from the pre-forming region in the second state.

Each of embodiments A, B, and C may have one or more of the followingadditional elements in any combination: Element 1: wherein the one ormore surgical clips comprises a plurality of surgical clips arranged inseries within the clip track, and wherein more distal surgical clips ofthe plurality of surgical clips are at least partially nested withinmore proximal surgical clips of the plurality of surgical clips. Element2: wherein the pre-forming region comprises opposed structural surfacesthat converge toward one another in a distal direction. Element 3:wherein the pre-forming region is defined by the first and second jawmembers. Element 4: wherein the first and second jaw members areactuated a first time to deform a given surgical clip of the one or moresurgical clips from the first state to the second state, and actuated asecond time to crimp the given surgical clip between the first andsecond jaw members. Element 5: further comprising a feeder shoe thatapplies an axial load on the one or more surgical clips positionedwithin the clip track to promote sequential feeding of the one or moresurgical clips, and a feedbar engageable with a distal-most surgicalclip of the one or more surgical clips to convey the distal-mostsurgical clip to the pre-forming region and subsequently to the firstand second jaw members. Element 6: further comprising a retention memberthat engages one or more surgical clips located distally within the cliptrack and prevents the one or more surgical clips from advancing intothe pre-forming region. Element 7: wherein the retention membercomprises a passive biasing device. Element 8: wherein the feeder shoefurther comprises a compression spring that supplies the axial load.Element 9: wherein the feedbar advances the distal-most surgical clipthrough the pre-forming region such that the pair of legs of thedistal-most surgical clip slidably engage the inner walls of thepre-forming region to transition the distal-most surgical clip to thesecond state. Element 10: wherein the feedbar comprises a firstengagement member engageable with the distal-most surgical clip, and asecond engagement member located proximal to the first engagement memberand simultaneously engageable with a penultimate surgical clip of theone or more surgical clips. Element 11: wherein a distal end of the cliptrack provides a ramped portion that repositions the one or moresurgical clips positioned at the ramped portion such that the feedbar isable to engage and distally advance the one or more surgical clips.Element 12: wherein a distal end of the pre-forming region is alignedwith the first and second jaw members.

Element 13: wherein the pre-forming region comprises opposed structuralsurfaces that converge toward one another in a distal direction, andwherein advancing the distal-most surgical clip to the pre-formingregion comprises engaging the distal-most surgical clip with a feedbar,conveying the distal-most surgical clip to the pre-forming region withthe feedbar, and advancing the distal-most surgical clip through thepre-forming region such that the pair of legs of the distal-mostsurgical clip slidably engage the opposed structural surfaces of thepre-forming region and transition the distal-most surgical clip to thesecond state. Element 14: wherein the pre-forming region is defined bythe first and second jaw members, and wherein deforming the distal-mostsurgical clip in the pre-forming region comprises conveying thedistal-most surgical clip to the pre-forming region with a feedbar, andactuating the first and second jaw members a first time to deform thedistal-most surgical clip to the second state within the pre-formingregion. Element 15: wherein the feedbar comprises a first engagementmember engageable with the distal-most surgical clip, and a secondengagement member located proximal to the first engagement member, andwherein advancing the distal-most surgical clip to the first and secondjaw members in the second state further comprises advancing thedistal-most surgical clip to the first and second jaw members with thefeedbar and simultaneously engaging the second engagement member on apenultimate surgical clip of the one or more surgical clips andadvancing the penultimate surgical clip to the pre-forming region, andactuating the first and second jaw members a second time to crimp thedistal-most surgical clip and simultaneously deform the penultimatesurgical clip to the second state within the pre-forming region.

Element 16: further comprising an articulable wrist joint interposingthe end effector and the elongate shaft.

By way of non-limiting example, exemplary combinations applicable to A,B, and C include: Element 3 with Element 4; Element 5 with Element 6;Element 6 with Element 7; Element 5 with Element 8; Element 5 withElement 9; Element 5 with Element 10; Element 5 with Element 11; andElement 14 with Element 15.

Therefore, the disclosed systems and methods are well adapted to attainthe ends and advantages mentioned as well as those that are inherenttherein. The particular embodiments disclosed above are illustrativeonly, as the teachings of the present disclosure may be modified andpracticed in different but equivalent manners apparent to those skilledin the art having the benefit of the teachings herein. Furthermore, nolimitations are intended to the details of construction or design hereinshown, other than as described in the claims below. It is thereforeevident that the particular illustrative embodiments disclosed above maybe altered, combined, or modified and all such variations are consideredwithin the scope of the present disclosure. The systems and methodsillustratively disclosed herein may suitably be practiced in the absenceof any element that is not specifically disclosed herein and/or anyoptional element disclosed herein. While compositions and methods aredescribed in terms of “comprising,” “containing,” or “including” variouscomponents or steps, the compositions and methods can also “consistessentially of” or “consist of” the various components and steps. Allnumbers and ranges disclosed above may vary by some amount. Whenever anumerical range with a lower limit and an upper limit is disclosed, anynumber and any included range falling within the range is specificallydisclosed. In particular, every range of values (of the form, “fromabout a to about b,” or, equivalently, “from approximately a to b,” or,equivalently, “from approximately a-b”) disclosed herein is to beunderstood to set forth every number and range encompassed within thebroader range of values. Also, the terms in the claims have their plain,ordinary meaning unless otherwise explicitly and clearly defined by thepatentee. Moreover, the indefinite articles “a” or “an,” as used in theclaims, are defined herein to mean one or more than one of the elementsthat it introduces. If there is any conflict in the usages of a word orterm in this specification and one or more patent or other documentsthat may be incorporated herein by reference, the definitions that areconsistent with this specification should be adopted.

As used herein, the phrase “at least one of” preceding a series ofitems, with the terms “and” or “or” to separate any of the items,modifies the list as a whole, rather than each member of the list (i.e.,each item). The phrase “at least one of” allows a meaning that includesat least one of any one of the items, and/or at least one of anycombination of the items, and/or at least one of each of the items. Byway of example, the phrases “at least one of A, B, and C” or “at leastone of A, B, or C” each refer to only A, only B, or only C; anycombination of A, B, and C; and/or at least one of each of A, B, and C.

What is claimed is:
 1. An end effector for a surgical clip applier,comprising: an elongate body; first and second jaw members positioned ata distal end of the body; a clip track provided within the body; one ormore surgical clips contained within the clip track, wherein eachsurgical clip includes a crown and a pair of legs extendinglongitudinally from the crown and diverging from each other at adiverging opening angle; a pre-forming region defined by the clip trackand comprising opposed structural surfaces that converge toward oneanother in a distal direction; and a feedbar engageable with adistal-most surgical clip of the one or more surgical clips to advancethe distal-most surgical clip through the pre-forming region and therebytransition the distal-most surgical clip from a first state, where thepair of legs diverge at the diverging opening angle, to a second state,where the diverging opening angle is minimized; and the distal-mostsurgical clip is prepared to be received by the first and second jawmembers and crimped.
 2. The end effector of claim 1, wherein the one ormore surgical clips comprises a plurality of surgical clips arranged inseries within the clip track, and wherein more distal surgical clips ofthe plurality of surgical clips are at least partially nested withinmore proximal surgical clips of the plurality of surgical clips.
 3. Theend effector of claim 1, further comprising a feeder shoe that appliesan axial load on the one or more surgical clips positioned within theclip track to promote sequential feeding of the one or more surgicalclips; wherein the feedbar conveys the distal-most surgical clip to thefirst and second jaw members.
 4. The end effector of claim 3, furthercomprising a retention member that engages the one or more surgicalclips located distally within the clip track and prevents the one ormore surgical clips from advancing into the pre-forming region.
 5. Theend effector of claim 4, wherein the retention member comprises apassive biasing device.
 6. The end effector of claim 3, wherein thefeeder shoe further comprises a compression spring that supplies theaxial load.
 7. The end effector of claim 3, wherein the feedbar advancesthe distal-most surgical clip through the pre-forming region such thatthe pair of legs of the distal-most surgical clip slidably engage theinner walls of the pre-forming region to transition the distal-mostsurgical clip to the second state.
 8. The end effector of claim 3,wherein a distal end of the clip track provides a ramped portion thatrepositions the one or more surgical clips positioned at the rampedportion such that the feedbar is able to engage and distally advance theone or more surgical clips.
 9. The end effector of claim 1, wherein adistal end of the pre-forming region is aligned with the first andsecond jaw members.
 10. The end effector of claim 1, wherein the one ormore surgical clips comprise a proximal surgical clip and a distalsurgical clip, and wherein, when the proximal and distal surgical clipsare contained within the clip track, the pair of legs of the proximalsurgical clip extends past and partially overlaps the pair of legs ofthe distal surgical clip.
 11. A method of operating an end effector of asurgical clip applier, comprising: positioning the end effector adjacenta patient for operation, the end effector including: an elongate body;first and second jaw members positioned at a distal end of the body; aclip track provided within the body; one or more surgical clipscontained within the clip track, wherein each surgical clip includes acrown and a pair of legs extending longitudinally from the crown anddiverging from each other at a diverging opening angle; a pre-formingregion defined by the clip track and comprising opposed structuralsurfaces that converge toward one another in a distal direction;distally advancing a distal-most surgical clip of the one or moresurgical clips through the pre-forming region with a feedbar; deformingthe distal-most surgical clip in the pre-forming region from a firststate, where the pair of legs of the distal-most surgical clip divergeat the diverging opening angle, to a second state, where the divergingopening angle is minimized and the distal-most surgical clip is preparedto be received by the first and second jaw members and crimped; andadvancing the distal-most surgical clip from the pre-forming region tothe first and second jaw members in the second state with the feed bar.12. The method of claim 11, wherein distally advancing the distal-mostsurgical clip through the pre-forming region comprises advancing thedistal-most surgical clip through the pre-forming region such that thepair of legs of the distal-most surgical clip slidably engage theopposed structural surfaces of the pre-forming region and transition thedistal-most surgical clip to the second state.
 13. A surgical clipapplier, comprising: a drive housing; an elongate shaft that extendsfrom the drive housing; and an end effector arranged at a distal end ofthe elongate shaft, the end effector including: an elongate body; firstand second jaw members positioned at a distal end of the body; a cliptrack provided within the body; one or more surgical clips containedwithin the clip track, wherein each surgical clip includes a crown and apair of legs extending longitudinally from the crown and diverging fromeach other at a diverging opening angle; a pre-forming region defined bythe clip track and comprising opposed structural surfaces that convergetoward one another in a distal direction; and a feedbar engageable witha distal-most surgical clip of the one or more surgical clips to advancethe distal-most surgical clip through the pre-forming region and therebytransition the distal-most surgical clip from a first state, where thepair of legs diverge at the diverging opening angle, to a second state,where the diverging opening angle is minimized and the distal-mostsurgical clip is prepared to be received by the first and second jawmembers and crimped.
 14. The surgical clip applier of claim 13, furthercomprising an articulable wrist joint interposing the end effector andthe elongate shaft.
 15. The surgical clip applier of claim 13, whereinthe one or more surgical clips comprise a proximal surgical clip and adistal surgical clip, and wherein, when the proximal and distal surgicalclips are contained within the clip track, the pair of legs of theproximal surgical clip extends past and partially overlaps the pair oflegs of the distal surgical clip.